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Flashcards in GI Deck (102):
1

Secretin

Produced by Duodenal S-endocrine cells → increases bicarb secretion from pancreas into small bowel

2

Risks of TPN (total parenteral nutrition)

Increased risk of gallstones as result of biliary stasis from decreased CCK due to absent enteral stimulation

3

Zenker Diverticulum Caused by _____

Cricopharyngeal motor dysfunction → increased pressure

4

Meckel Diverticulum is a remnant of ______ vs Cyst/Fistula from Bladder is from _________

- Yolk Sac (vitelline duct)
- Allantois (urachus)

5

Lesser Omentum

On lesser curvature and is made up of hepatoduodenal (portal vein, hepatic artery, common bile duct) and hepatogastric ligaments

6

Globus Hystericus

“Lump in throat”, fairly common, triggered by emotions

7

Effect of Portal HTN on Splenic Vein

Portal hypertension in cirrhosis → splenic vein hypertension and splenomegaly (due to venous accumulation) → congestion of blood in spleen → apparent red pulp expansion

8

Ischemic Colitis

Mucosal hemorrhage and patchy
- Aw/ severe atherosclerosis (may have weak lower extremity pulses)

9

Effect of Bile Acids on Microbes

Bile acids can emulsify the membranes of microbes in gut (may have bacterial overgrowth without them)

10

Crohn's MC in:

Terminal Ileum

11

Lactulose

Treats hepatic encephalopathy by acidifying GI tract contents

12

Ethylene Glycol Poisoning

Sudden onset back pain, hematuria, and oliguria w/ high anion gap metabolic acidosis
- Calcium oxalate crystals in urine

13

Brunner’s glands, Crypts of Leiberkuhn, and Goblet Cells

- In submucosa of the duodenum secrete alkaline fluid
- Crypts of Leiberkuhn deliver secretions and where stem cells reside
- Goblet cells make mucus

14

OATP

Liver takes up unconjugated bilirubin passively through OATP (organic anion transporting polypeptide)
- MOAT is to transport out conjugated bili (active transport)

15

Fitz-Hugh-Curtis

Neisseria Gonorrhea, violin string adhesions to liver
- Different from Waterhouse Friedrichson (Neisseria meningitidis, hemorrhaging adrenal crisis)

16

7-a-Hydroxylase

Converts cholesterol to bile acids
- Inhibited by fibrates → excess cholesterol in bile → cholesterol gall stones

17

Main Site of Lipid Absorption

Jejunum

18

Damage to Hepatocytes in HepB due to:

CD8 mediated damage to infected hepatocytes due to presence of the virus causes (HepB does not have cytotoxic effect)

19

Window Period for HepB

HBsAg and HBsAb are both undetectable

20

Intussusception

MC bowel obstruction from 3mo-6yrs (peak b/w 5-10mo)→ currant jelly stools
- telescoping bowel

21

Congenital pyloric stenosis

3-4 week old w/ projectile vomiting and olive mass in abdomen

22

Ascaris Lumbricoides

- High pitched tinkly/steel drum bowel sounds
- Can cause Type 1 hypersensitivity
- Most potent allergen

23

Stool Findings for:
Strongyloides roundworm
Tapeworms
Protazoa (Giardia, Histolytica)
Schistosomiasis

- Strongyloides roundworm: rhabditiform larvae in stool
- Tapeworms: proglottids
- Protazoa (giardia, histolytica): trophozoites and cysts
- Schistosomiasis: eggs

24

Risk of Using Fibrates and Bile-Acid Binding Resins Together

Gallstones

25

Bile Acid Binding Resins (cholestyramine)

- Side effects: increased triglycerides and cholesterol gallstones
- Often used with statins, but should be taken at least 4 hours apart because it decreases statin absorption
- also increase hepatic cholesterol synthesis

26

Menetrier's Disease

Protein losing enteropathy due to excess mucus production (mucin cell hyperplasia)
- commonly in elderly

27

Villous Adenomas

- Can secrete large amounts of mucus → secretory diarrhea
- Can be cauliflower like shaped projections
- Risk of colorectal cancer

28

Esophageal Varices

Portal HTN → anastomosis of left gastric (portal) with esophageal veins (caval system)

29

Caput Medusa

anastomosis of paraumbilical veins (portal) with superficial abdominal veins

30

Internal Hemorrhoids

anastomosis of superior rectal veins (portal) with inferior rectal veins

31

HNPCC

(Lynch Syndrome)
MLH1 and MSH2 gene mutations
- mismatch repair problem

32

Fulminant Liver Failure in Pregnant Women

HepE

33

Hep B

- usually sexually transmitted
- integrates into genome

34

Hep C

- usually IV drug abuse
- RNA w/o reverse transcriptase so cannot integrate into genome

35

Hep A

- fecal oral
- dark urine due to increased serum bilirubin

36

Plummer Vinson Triad

atrophic glossitis, iron deficiency, esophageal webs
- also increased risk squamous cell carcinoma

37

ETEC

- traveler’s diarrhea
- LT enterotoxin is a cholera-like toxin

38

Air in Biliary Tree

Fistula between gall bladder and bowel allows stone into gut and it will get stuck at ileocecal valve (gallstone ileus)

39

Upper Glandular Gastric Layer

Parietal Cells (secrete acid)

40

Deep Glandular Gastric Layer

Chief Cells (secrete pepsinogen)

41

Hepatoduodenal Ligament

portal vein, hepatic artery, and common bile duct

42

Systemic Mastocytosis

clinical signs of too much histamine (flushing, itching, etc) and increased gastric acid production due to the increased histamine

43

Imperforate Anus

- commonly found with other genitourinary abnormalities
- Also VACTERL (vertebral, anal atresia, tracheoesophageal fistula, esophageal atresia, renal and limb abnormalities

44

Abetalipoproteinemia

Fat accumulation at the tips of villi in the intestine because the fat cannot be put into the blood (it just accumulates in enterocytes)
- Will see acanthocytes in blood

45

Polyethylene Glycol

osmotic laxative (similar mechanism to lactase deficiency)

46

Motion Sickness Prevention

Antimuscarinics and antihistamines w/ antimuscarinic activity are most effective

47

Intergluteal Pilonidal Disease

acquired skin infection involing upper natal cleft of the buttocks, may present with draining sinus tracts

48

Volvulus

Midgut rotation around SMA failure

49

HepB Infected Hepatocyte Destruction

Host CD8 cytotoxic T cells kill hepatocytes because their cell surface presents hep B antigens

50

Hemorrhage due to Ulcer

- Lesser curvature: left gastric
- Posterior duodenum: gastroduodenal

51

Diphenoxylate and Loperamide

- used as antidiarrheal by decreasing motility
- Acts at mu receptors (opioid) in GI tract
- Higher doses → euphoria and physical dependence
- Combine with atropine to prevent abuse

52

Signet Ring Cells

Diffuse Gastric Adenocarcinoma (mucus in cell pushes nucleus to side)

53

Acute Pancreatitis

Usually gallstones or alcohol, but can be from hypertriglyceridemia

54

SPINK1

Pancreatic trypsin inhibitor (prevents autodigestion of pancreas)

55

Mallory Weiss: metabolic effect

repetitive vomiting → metabolic alkalosis from vomiting up gastric acid

56

Fidoxamicin

(oral) for C. Diff has minimal systemic absorption and is bactericidal
(Vanco and metronidazole are bacteriostatic)

57

Lactase Deficiency

Increased stool osmolarity
Decreased stool pH, and Increased breath hydrogen
- lactase gene expression decreases/downregulated with age

58

Crohn's vs UC: T cells

Crohn’s: TH1 mediated (non-caseating granulomas)
UC: TH2 mediated

59

Sporadic Colorectal Cancer mutations

APC → K-RAS → p53 & DCC

60

Arsenic or Polyvinyl Chloride

Liver hemangiosarcoma
- Arsenic poisoning should be treated with Dimercaprol

61

Whipple's Disease

- T. Whippelii
- Foamy large macrophages filled with PAS+ granules and bacilli in small intestine mucosa
- Malabsorptive diarrhea and arthropathy

62

Salmonella Typhi

- typhoid fever
- travel followed by watery diarrhea that becomes blood (due to bowel perforation)
- salmon colored spotty rash on torso

63

Curling Ulcers

In burn patients

64

Cushing Ulcers

Related to head trauma

65

CYP 450 found in Zone

Zone 3

66

Peyers patches and largest number of goblet cells found in ____

Ileum

67

Intestinal Atresia

Apple peel atresia due to vascular accident

68

Above Pectinate Line

- Super rectal artery (of IMA)
- Superior rectal vein (to IMV – portal)
- Not painful (visceral innervation)
- Lymph drains to deep nodes

69

Below Pectinate Line

- Inferior and middle rectal artery (of pudendal artery)
- Inferior rectal vein (to internal pudendal → internal iliac → IVC – non-portal)
- Painful (somatic innervation, inf rectal branch of pudendal)
- Lymph drains to superficial inguinal nodes

70

Very low infectious inoculation

Giardia, Entaemoba, Shigella, and Campylobacter

71

Excess copper mainly excreted by:

hepatic excretion into bile, and partly through urine

72

D-xylose

- monosaccharide (doesn’t need action of pancreatic enzymes to be absorbed)
- Used to test for malabsorption

73

Ulcer Location: Zollinger Ellison vs Peptic Ulcer Disease

- Zollinger Ellison: distal duodenum
- Peptic ulcer disease: proximal duodenum or lesser curvature of stomach

74

Portal Vein Thrombosis vs Budd Chiari

- Portal vein thrombosis does not cause any histologic changes to liver --> portal HTN
- Budd-Chiari (blocks hepatic vein) would have centrilobular congestion w/ portal HTN

75

Meconium Ileus

due to dehydrated mass of meconium blocking ileocecal valve caused by Cystic Fibrosis

76

Non-neoplastic GI polyps

Hamartomatous, Hyperplastic, and Inflammatory
- no risk of transforming into cancer (unlike adenomatous polyps)

77

Pancreas: Ventral Bud

Main pancreatic duct (part), inferior and posterior part of the head, and the uncinate process

78

Pancreas: Dorsal Bud

Main pancreatic duct, body, tail, and most of the head

79

Left Sided Colon Cancer

Obstructive (infiltration of intestinal wall encircling the lumen) --> change in stool caliber, constipation, cramping pain, abdominal distension, nausea, and vomiting

80

Ride Sided Colon Cancer

Exophytic mass that does not develop obstruction (right side is larger)
- iron deficiency anemia due to ongoing blood loss, anorexia, weight loss, fatigue

81

PPIs

Block final common pathway of gastic acid secretion from parietal cells (so no effect with Ach via vagus, histamine, or gastrin)
- Histamine blockers only block the Histamine receptors and M3 blockers will only block the vagus effect

82

Diffuse Esophageal Spasms can mimic

Angina Pectoralis

83

Middle aged women w/ long history of pruritis and fatigue presenting w/ pale stool and xanthelasma

Primary Biliary Cirrhosis (PBC)

84

Male with long history of UC w/ fatigue and high alkaline phostphatase

Primary Sclerosing Cholangitis (PSC)

85

Pancreatic Pseudocyst

MC occurs after acute appendicitis
-Round fluid filled space in parenchyma of pancreas (90% in tail)

86

Fibrosis between Nodules

Cirrhosis
Regenerative nodules are made up of proliferating hepatocytes

87

Cryptosporidium in AIDS

Chronic watery diarrhea

88

High Estrogen in Cirrhosis

Spider angiomas, gynecomastia, testicular atrophy, decreased body hair, palmar erythema, and Dupuytren's contractures

89

"Crypt abscesses"

Seen with Ulcerative Colitis (UC)
- neutrophils accumulate in crypt lumina
erythematous, friable granular mucosa

90

Kayser Fleischer Rings

- aw/ Wilsons Disease
- Brownish or gray-green rings of fine granular copper deposits in Descemets membrane of the Cornea

91

H. Pylori Gastric Ulcer

H. pylori produces proteases and particularly urease, which allow it to decrease the pH of the its local environment by cleaving urea into ammonia, which is toxic to gastric mucosa

92

Killing C. Difficile Spores

- Handwashing with soap is necessary
- Equipment should be autoclaved (steam) to clean it
- Alcohol-based rubs are not sufficient to kill the spores

93

Fluid in Lesser Sac

Fluid is contained in a space behind the stomach but in front of the retroperitoneal structures (e.g. the pancreas)

94

TIPs Procedure

Surgical portosystemic shunts to decrease Portal HTN
- MC is creating an intrahepatic shunt between the portal and hepatic veins
- can also anastomose the splenic vein to the nearby left renal vein

95

Gall bladder cannot be visualized on a radionuclide biliary scan

Acute Cholecystitis w/ gallstone obstruction of cystic duct

96

Chronic Mesenteric Ischemia

"intestinal angina"
Atherosclerosis of mesenteric arteries causing diminished blood flow to intestine after meals --> post-prandial epigastric pain
- aw/ food aversion and weight loss

97

Non-infective envelop glycoprotein that forms spheres and tubules 22 nm in diameter

HBsAg
usually secretes in huge quantities

98

Nucleocapsid core and pre-core protein that is a marker of high infectivity

HBeAg

99

For Hepatitis D virus to infect:

the HBsAg of HepB must coat the HDAg of hepatitis D before it can infect hepatocytes and multiply

100

Most Dangerous Complication of UC

Toxic megacolon (can lead to perforation)
Do not do barium enema or colonoscopy
Can do an X-ray

101

Crohns: Oxalate Kidney Stones

Impaired bile acid absorption --> subsequent fat malabsorption -->lipids bind calcium ions and the soap complex is excreted --> free oxalate absorbed
- the oxalate is normally bound by calcium in the intestine so it gets excreted

102

Vagus on G cells

Releases GRP